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Renale Sympathikusdenervation bei therapierefraktärer arterieller Hypertonie

Renal sympathetic denervation for therapy refractive arterial hypertension

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Zusammenfassung

Patienten mit therapierefraktärer arterieller Hypertonie weisen eine deutliche Überaktivität des sympathischen Nervensystems auf und verfügen über eine schlechte kardiovaskuläre Prognose. Bei Patienten mit systolischen Blutdruckwerten von 160 mmHg oder mehr (≥150 mmHg bei Diabetes mellitus Typ 2) konnte mittels der selektiven minimal-invasiven renalen Sympathikusdenervation (RD) in über 85% der Fälle eine Blutdrucksenkung von mindestens 10 mmHg systolisch erzielt werden. Der gegenwärtige Stand multizentrischer Studien belegt eine anhaltende Blutdrucksenkung nach RD über eine Nachbeobachtungsdauer von über 3 Jahren, wobei im Verlauf die Ansprechrate auf die Intervention weiter zuzunehmen scheint. Zudem konnte eine positive Beeinflussung von Folgezuständen und Endorganschäden der arteriellen Hypertonie gezeigt werden. Derzeit ist die Indikation der RD auf Patienten mit schwerer therapierefraktärer Hypertonie beschränkt. Der Einfluss der RD auf die Langzeitprognose dieser Patienten bleibt abzuwarten.

Abstract

In patients with therapy refractive arterial hypertension an overactivity of the sympathetic nervous system is the driving force of end-organ damage and poor cardiovascular prognosis. In patients with systolic blood pressure values of ≥160 mmHg (≥150 mmHg in type 2 diabetes mellitus) a blood pressure reduction of ≥10 mmHg in more than 85% of this difficult patient group could be achieved with the new technique of minimally invasive selective renal sympathetic denervation (RD). The current status of controlled multicentric clinical trails proves a sustained treatment effect for more than 3 years of follow-up. Even with longer follow-up times the treatment efficacy seems to increase further due to late RD responders. Smaller clinical trials indicate a beneficial effect of RD on secondary effects and end-organ damage correlated with refractory hypertension. The impact of RD on long-term prognosis of hypertensive patients remains to be investigated by trials with sufficient follow-up duration and statistical power.

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Interessenkonflikt

Der korrespondierende Autor weist für sich und seinen Koautoren auf folgende Beziehungen hin: Tätigkeit als Referent im Medtronic Academia Programm (MCB); Mitglied im Advisory Board für Medtronic, Vortragstätigkeit und klinische Studien für Medtronic und Vessix Vascular (UCH).

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  1. Universitätsklinik für Innere Medizin II, Paracelsus Medizinische Universität Salzburg, Müllner Hauptstr. 48, A-5020, Salzburg, Österreich

    M.C. Brandt & U.C. Hoppe

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  1. M.C. Brandt
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  2. U.C. Hoppe
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Correspondence to M.C. Brandt.

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Brandt, M., Hoppe, U. Renale Sympathikusdenervation bei therapierefraktärer arterieller Hypertonie. Kardiologe 6, 443–454 (2012). https://doi.org/10.1007/s12181-012-0447-2

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